Does Including Facebook Training Improve the Effectiveness of Computerized Cognitive Training? A Randomized Controlled Trial.

OBJECTIVE: To determine whether implementing a Facebook training program improves the effectiveness of computerized cognitive training (CCT) in older adults. DESIGN: Randomized, controlled, double single-blind trial with parallel groups. SETTING: Community centers. SUBJECTS: Eighty-six adults between 60 and 90 years old. INTERVENTIONS: Nine face-to-face 60-min sessions of CCT with VIRTRAEL for all participants. The experimental group received an additional 30 min of Facebook training per session. MAIN MEASURES: Attention (d2 Test of Attention); learning and verbal memory (Hopkins Verbal Learning Test-Revised); working memory (Letter-Number Sequencing test), semantic and abstract reasoning (Similarities and Matrix Reasoning tests); and planning (Key Search test). RESULTS: There was a significant Group*Time interaction in the Hopkins Verbal Learning Test-Revised-Trial 3, Letter-Number sequencing, and Matrix tests. Between groups, post-hoc analyses showed a difference in Matrix reasoning (p < .001; d = 0.893) at post-intervention in favor of the experimental group. Significant main effects of time were found in the CCT group between baseline and 3-month follow-up for Concentration (F = 26.431, p ≤ .001), Letters and Numbers (F = 30.549, p ≤ .001), Learning (F = 38.678, p ≤ .001), Similarities (F = 69.885, p ≤ .001), Matrix (F = 90.342, p ≤ .001), and Key Search (F = 7.904, p = .006) tests. CONCLUSIONS: The utilization of CCT with VIRTRAEL, a freely accessible tool with broad applicability, resulted in enhanced attention, verbal learning, working memory, abstract and semantic reasoning, and planning among older adults. These improvements were sustained for at least three months post-training. Additional training in Facebook did not enhance the effectiveness of CCT.

Angiogenic imbalance in maternal and cord blood is associated with neonatal birth weight and head circumference in pregnancies with major fetal congenital heart defect.

OBJECTIVES: To ascertain whether abnormalities in neonatal head circumference and/or body weight are associated with levels of angiogenic/antiangiogenic factors in the maternal and cord blood of pregnancies with a congenital heart defect (CHD) and to assess whether the specific type of CHD influences this association. METHODS: This was a multicenter case-control study of women carrying a fetus with major CHD. Recruitment was carried out between June 2010 and July 2018 at four tertiary care hospitals in Spain. Maternal venous blood was drawn at study inclusion and at delivery. Cord blood samples were obtained at birth when possible. Placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) were measured in maternal and cord blood. Biomarker concentrations in the maternal blood were expressed as multiples of the median (MoM). RESULTS: PlGF, sFlt-1 and sEng levels were measured in the maternal blood in 237 cases with CHD and 260 healthy controls, and in the cord blood in 150 cases and 56 controls. Compared with controls, median PlGF MoM in maternal blood was significantly lower in the CHD group (0.959 vs 1.022; P < 0.0001), while median sFlt-1/PlGF ratio MoM was significantly higher (1.032 vs 0.974; P = 0.0085) and no difference was observed in sEng MoM (0.981 vs 1.011; P = 0.4673). Levels of sFlt-1 and sEng were significantly higher in cord blood obtained from fetuses with CHD compared to controls (mean ± standard error of the mean, 447 ± 51 vs 264 ± 20 pg/mL; P = 0.0470 and 8.30 ± 0.92 vs 5.69 ± 0.34 ng/mL; P = 0.0430, respectively). Concentrations of sFlt-1 and the sFlt-1/PlGF ratio in the maternal blood at study inclusion were associated negatively with birth weight and head circumference in the CHD group. The type of CHD anomaly (valvular, conotruncal or left ventricular outflow tract obstruction) did not appear to alter these findings. CONCLUSIONS: Pregnancies with fetal CHD have an antiangiogenic profile in maternal and cord blood. This imbalance is adversely associated with neonatal head circumference and birth weight. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Arterial pulsation modulates the optical attenuation coefficient of skin.

Photoplethysmographic (PPG) signals arise from the modulation of light reflectivity on the skin due to changes of physiological origin. Imaging plethysmography (iPPG) is a video-based PPG method that can remotely monitor vital signs in a non-invasive manner. iPPG signals result from skin reflectivity modulation. The origin of such reflectivity modulation is still a subject of debate. Here, we have used optical coherence tomography (OCT) imaging to find whether iPPG signals may result from skin optical properties being directly or indirectly modulated by arterial transmural pressure propagation. The light intensity across the tissue was modeled through a simple exponential decay (Beer-Lambert law) to analyze in vivo the modulation of the optical attenuation coefficient of the skin by arterial pulsation. The OCT transversal images were acquired from a forearm of three subjects in a pilot study. The results show that the optical attenuation coefficient of skin changes at the same frequency as the arterial pulsation due to transmural pressure propagation (local ballistographic effect), but we cannot discard the contribution of global ballistographic effects.

Defective chaperone-mediated autophagy is a hallmark of joint disease in patients with knee osteoarthritis.

OBJECTIVE: Defects in autophagy contribute to joint aging and Osteoarthritis (OA). Identifying specific autophagy types could be useful for developing novel treatments for OA. DESIGN: An autophagy-related gene array was performed in blood from non-OA and knee OA subjects from the Prospective Cohort of A Coruña (PROCOAC). The differential expression of candidate genes was confirmed in blood and knee cartilage and a regression analysis was performed adjusting for age and BMI. HSP90A, a chaperone mediated autophagy (CMA) marker was validated in human knee joint tissues, as well as, in mice with aging-related and surgically-induced OA. The consequences of HSP90AA1 deficiency were evaluated on OA pathogenesis. Finally, the contribution of CMA to homeostasis was studied by assessing the capacity to restore proteostasis upon ATG5-mediated macroautophagy deficiency and genetic HSP90AA1 overexpression. RESULTS: 16 autophagy-related genes were significantly down-regulated in blood from knee OA subjects. Validation studies showed that HSP90AA1 was down-regulated in blood and human OA cartilage and correlated with risk incidence of OA. Moreover, HSP90A was reduced in human OA joints tissues and with aging and OA in mice. HSP90AA1 knockdown was linked to defective macroautophagy, inflammation, oxidative stress, senescence and apoptosis. However, macroautophagy deficiency increased CMA, highlighting the CMA-macroautophagy crosstalk. Remarkably, CMA activation was sufficient to protect chondrocytes from damage. CONCLUSIONS: We show that HSP90A is a key chaperone for chondrocyte homeostasis, while defective CMA contributes to joint damage. We propose that CMA deficiency is a relevant disease mechanism and could represent a therapeutic target for OA.

Efectividad de tres métodos de desobturación sobre modelos réplica / Effectiveness of three unsealing methods on replica models

El objetivo fue evaluar la eficacia de remoción del material de obturación y el tiempo empleado para la desobturación con tres métodos diferentes, en modelos réplica. Se utilizaron 24 modelos réplica de premolares inferiores instrumentados con sistema Protaper Gold hasta F4, irrigación NaOCl 2,5% y ED-TAC 17%. Obturación termoplastizada sistema Fast Pack Pro. La muestra (n=24) se dividió aleatoriamen-te en tres grupos experimentales (n=8) sometidos a distintos métodos de desobturación. Grupo 1: fresas Gates Glidden II/III y limas Hedstroem. Grupo 2: lima Medium sistema Wave One Gold y punta ultrasóni-ca Ultra X, (Eighteeth). Grupo 3: lima Rotate 35/04 y punta ultrasónica R1 Clearsonic, (Helse). Se midió el tiempo de desobturación. Las piezas se radiogra-fiaron con radiovisiógrafo digital RVG 5200 (Cares-tream), y fueron procesadas con software Image-J. Al analizar cantidad de material de obturación rema-nente, la prueba de Kruskal-Wallis (p<0,05), mostró diferencias estadísticamente significativas entre grupos 2 y 3. Grupo 1 no mostró diferencias signifi-cativas con los otros dos (p>0,05). Al analizar tiempo de desobturación, el test de Kruskal-Wallis no deter-minó diferencias significativas entre grupos 1 y 2 (p>0,05), el grupo 3 tuvo diferencias estadísticamen-te significativas con los grupos 1 y 2 (p<0,05). En con-clusión, ninguno de los sistemas de desobturación evaluados logró eliminar la totalidad del material de obturación. El que combinó limas rotatorias con punta ultrasónica de retratamiento fue el que mos-tró mayor efectividad de remoción y demandó menor tiempo de trabajo (AU)

Objective: to evaluate the effectiveness of obturation material removal and the time that the procedure took, when performing the retreatment with three different methods, in replica models of mandibular premolars. Materials and methods: 24 replica models of lower premolars instrumented with Protaper Gold system up to F4, 2.5% NaOCl irrigation and 17% ED-TAC were used. Thermoplastized sealing with Fast Pack Pro system. The sample (n=24) was randomly divided in three experimental groups (n=8) subjected to different unsealing methods. Group 1: Gates Glid-den burs II and III and Hedstroem files. Group 2: Wave One Gold Medium file system and Ultra X ultra-sonic tip, (Eighteeth). Group 3: Rotate 35/04 file and R1 Clearsonic ultrasonic tip (Helse). Unsealing time was measured. The samples were radiographed with a digital radiovisiograph RVG 5200 (Carestream), and processed with Image-J software. When analyzing the amount of remaining filling material, Kruskal-Wallis test showed statistically significant differences be-tween groups 2 and 3 (p<0,05). Group 1 did not show significant differences with the other two (p>0,05). When analyzing unsealing time, Kruskal-Wallis test determined that there were no significant differ-ences between groups 1 and 2 (p>0,05), but group 3 had statistically significant differences with the other two (p<0.05). None of the unsealing systems evalu-ated managed to eliminate all of the sealing material. The group that combined rotary files with ultrasonic retreatment tip showed the greatest removal effec-tiveness and required less work time (AU)

Ránula cervical gigante: a propósito de un caso

La ránula es una lesión pseudoquística causada por la retención de contenido salival de la glándula sublingual en el tejido conjuntivo subyacente, siendo la patología más frecuente de esta glándula. Su localización es a nivel del suelo de la boca, pudiendo en ocasiones extenderse a través del músculo milohioideo hacia la región submaxilar o cervical (ránula plunging o cervical), presentándose clínicamente como una tumoración laterocervical de crecimiento lento. El apoyo de imágenes mediante ecografía, tomografía computarizada, o RM (resonancia magnética) es fundamental para un correcto diagnóstico. Respecto al tratamiento, el procedimiento más aceptado y con menos tasas de recurrencia es la escisión de la ránula cervical por abordaje laterocervical, asociada a la extirpación de la glándula sublingual implicada vía transoral. Aquí presentamos el caso clínico de un varón de 25 años quien presenta una masa laterocervical derecha de seis meses de evolución de crecimiento progresivo e indoloro. La ecografía y RM confirman una ránula cervical gigante de 62x45x101 mm, que se localiza en espacio submandibular derecho, alcanzando el espacio parafaríngeo en su vertiente más craneal. Debido a las características de la lesión y su anatomía se decide tratamiento quirúrgico.

The ranula is a pseudocystic lesion caused by the retention of salivary content of the sublingual gland in the underlying connective tissue, being the most frequent pathology of this gland. Its location is at the level of the floor of the mouth and can sometimes extend through the mylohyoid muscle towards the submaxillary or cervical region (plunging or cervical ranula), clinically presenting as a slow-growing laterocervical tumor. The support of images by ultrasound, computed tTomography or MRI (magnetic resonance imaging) is essential for a correct diagnosis. Regarding treatment, the most accepted procedure, and with the lowest recurrence rates is excision of the cervical ranula by the laterocervical approach, associated with the transoral removal of the involved sublingual gland. Here, we present the clinical case of a 25-year-old man who presented a six-month-old right laterocervical mass of progressive and painless growth. Ultrasound and MRI confirmed a giant cervical ranula measuring approximately 62x45x101 mm, located in the right submandibular space, reaching the parapharyngeal space in its most cranial aspect. Due to the characteristics of the injury and its anatomy, surgical treatment was decided.

Evaluación de los efectos de un dispositivo de entrenamiento de los músculos inspiratorios sobre la oxigenación muscular y la activación neuromuscular de los músculos respiratorios / [Evaluation of the effects of an inspiratory muscle training device on muscle oxygenation and neuromuscular activation of the respiratory muscles]

Objetivo: Comparar los cambios en la actividad electromiográfica y oxigenación muscular periférica de los músculos intercostales, en su condición de musculatura accesoria a la respiración, en pacientes con EPOC durante la realización de un test de marcha de 6 minutos (TM6M) con y sin el uso de un dispositivo FeelBreathe (FB).Material y métodos: Se seleccionaron a 20 sujetos diagnosticados de EPOC a los que se les realizaron dos TM6M separados al menos por 60 minutos. Aleatoriamente, cada uno de los pacientes realizó dos TM6M, uno usando el dispositivo FB y el otro sin FB (SFB) y se midieron durante la realización de ambos TM6M la actividad electromiográfica (EMG) obteniéndose la raíz de la media cuadrática (RMS), y por otro lado la oxigenación tisular de los músculos intercostales a través de la variable de oxihemoglobina (HbO2).Resultados: No hubo diferencias significativas en la distancia recorrida en ambos TM6M con FC a SFB. Tanto la RMS como la oxigenación tisular mostraron valores similares entre la condición FB vs. SFB al final de ambas pruebas (32,26 ± 101,94 μV vs 28,25 ± 87,02 μV; p = 0,16 y 70,63 ± 18,80 vs 70,74 ± 16,77; p = 0,975 respectivamente).Conclusiones: El estímulo de trabajo de la musculatura intercostal durante el TM6M con el dispositivo FB no compromete la aparición de la fatiga temprana por un exceso de activación o disminución de la oxigenación de dichos músculos al nivel de intensidad del TM6M. (AU)

Objective: To compare changes in electromyographic activity and peripheral muscle oxygenation of the intercostal muscles, in their condition as accessory muscles for respiration, in patients with COPD during a 6-minute walk test (6MWT) with and without the use of a FeelBreathe (FB) device.Material and methods: 20 subjects diagnosed with COPD who underwent two 6MTMs separated by at least 60 minutes were selected. Randomly, each of the patients underwent two 6MWT, one using the FB device and the other without FB (SFB) and electromyographic activity (EMG) was measured during the performance of both 6MWT, obtaining the root mean square (RMS), and on the other hand, tissue oxygenation of the intercostal muscles through the oxyhemoglobin (HbO2) variable.Results: There were no significant differences in the distance traveled in both 6MWT with HR to SFB. Both RMS and tissue oxygenation showed similar values between the FB condition vs. SFB at the end of both tests (32.26 ± 101.94 μV vs 28.25 ± 87.02 μV; p = 0.16 and 70.63 ± 18.80 vs 70.74 ± 16.77; p = 0.975 respectively).Conclusions: The work stimulus of the intercostal muscles during the 6MWT with the FB device does not compromise the appearance of early fatigue due to excessive activation or decreased oxygenation of these muscles at the intensity level of the 6MWT. (AU)

Non-functional alternative splicing caused by a Latino pathogenic variant in a case of PMM2-CDG.

We report on a Mexican mestizo with a multisystemic syndrome including neurological involvement and a type I serum transferrin isoelectric focusing (Tf IEF) pattern. Diagnosis of PMM2-CDG was obtained by clinical exome sequencing (CES) that revealed compound heterozygous variants in PMM2, the encoding gene for the phosphomannomutase 2 (PMM2). This enzyme catalyzes the conversion of mannose-6-P to mannose-1-P required for the synthesis of GDP-Man and Dol-P-Man, donor substrates for glycosylation reactions. The identified variants were c.422G>A (R141H) and c.178G>T, the former being the most frequent PMM2 pathogenic mutation and the latter a previously uncharacterized variant restricted to the Latino population with conflicting interpretations of pathogenicity and that we here report causes leaky non-functional alternative splicing (p.V60Cfs*3).

Mortalidad quirúrgica durante pandemia de coronavirus en un centro universitario / Surgical mortality during a coronavirus pandemic in a university center

Resumen Introducción: La pandemia de coronavirus, iniciada en Wuhan el año 2019, ha trastocado al mundo y afectado profundamente a la actividad quirúrgica al restringir el número de intervenciones en forma dramática, después de los reportes iniciales de mortalidad posoperatoria sobre el 20% en pacientes operados portadores de COVID. El objetivo del presente estudio fue evaluar las cifras de mortalidad quirúrgica, en pacientes intervenidos quirúrgicamente durante la pandemia del COVID-19. Materiales y Método: Cohorte retrospectiva de pacientes operados entre el 15 de marzo de 2020 y el 31 de julio de 2020 en un centro universitario. Se evaluó variables clínicas asociadas a la intervención quirúrgica y coinfección por SARS-CoV-2. Resultados: Se analizaron 344 pacientes quienes presentaron una mortalidad global de 6,1%. Se realizó examen de PCR para COVID a 153 pacientes. Presentaron un riesgo de mortalidad significativo los pacientes: PCR COVID(+) (22,7%), p = 0,01, portadores de hipertensión arterial (11,6%) p = 0,03 y mayores de 60 años (12,4%) p < 0,001. No fueron factores estadísticamente significativos de mayor riesgo de mortalidad, las siguientes variables: género, obesidad, diabetes mellitus, patología oncológica, cirugía de urgencia y clasificación de ASA. Al analizar dos subgrupos se observó que los pacientes menores de 60 años COVID negativo presentaron una cifra de mortalidad de 1,26% versus 36,3% en los mayores de 60 años, COVID positivos (p = 0,01). Discusión: Los resultados del presente estudio sugieren que se deben realizar los mayores esfuerzos para descartar la infección por SARS-CoV-2 en la evaluación preoperatoria para disminuir los riesgos de mortalidad posoperatoria.

Background: The coronavirus pandemic, started in the city of Wuhan in 2019, has disrupted the world and deeply affected surgical activity. Restricting the number of interventions dramatically, after initial reports of postoperative mortality over 20% in patients with COVID. The purpose of this study is to evaluate the figures for surgical mortality, during the coronavirus pandemic. Materials and Method: Retrospective cohort of patients operated between March 15, 2020 and July 31, 2020 at a university center. Clinical variables associated with surgical intervention and coinfection by SARS-CoV-2 were evaluated. Results: 344 patients with an overall mortality of 6.1% were analyzed. PCR testing for COVID was performed on 153 patients. Only from the ninth week of the pandemic did routine preoperative testing begin. Patients who presented a higher risk of mortality were: PCR COVID(+) (22.7%), arterial hypertension (11.6%) and age over 60 years (12.4%). In the present series, the following variables were not statistically significant risk factors for mortality: gender, obesity, diabetes mellitus, oncological pathology, emergency surgery and ASA classification. When analyzing two subgroups, we observed that COVID negative patients under 60 had a mortality rate of 1.26%, versus 36.36% in those over 60 years of age, COVID positive. Discussion: The results of the present study lead us to make every effort to rule out COVID infection preoperatively to reduce the risks of postoperative mortality. Although this is a series of cases and the extrapolation of its results should be cautious, having national figures can be a useful element to make decisions in this stage of reactivation of surgical activity.

Cáncer de mama triple negativo: terapias sistémicas actuales y experiencia local / Triple negative breast cancer: current systemic therapy and local experience

Resumen El cáncer de mama (CM) es la principal causa de muerte por cáncer en mujeres chilenas. Es una enfermedad heterogénea, en la cual se han identificado cuatro subtipos básicos, determinados según características clínicas, histológicas y moleculares, los que se relacionan a estrategias terapéuticas. El CM triple negativo (CMTN) se caracteriza por su agresividad, recaída temprana y mayor tendencia a presentarse en etapas avanzadas. Frecuentemente afecta a mujeres jóvenes o con antecedentes familiares de CM u ovario. La única terapia sistémica aprobada para el CMTN es la quimioterapia; sin embargo, recientemente terapias moleculares con inhibidores de puntos de control inmune e inhibidores de la poli-adenosina difosfato ribosa polimerasa, han mostrado eficacia en pacientes seleccionados, y se han agregado al arsenal terapéutico para CMTN. Dada la aparición de estas nuevas estrategias, parece relevante entender la heterogeneidad de esta enfermedad, los mecanismos de acción de las nuevas terapias, resultados clínicos y criterios de selección de pacientes para terapias moleculares. Presentamos una revisión de la terapia sistémica actual del CMTN.

Breast cancer is the leading cause of cancer death in Chilean women and worldwide. It is a heterogeneous disease and four different subtypes have been identified based on clinical, histological and molecular features, which correlate with different treatment tumor sensitivity. Triple negative breast cancer is characterized by its aggressiveness, early relapse, and a greater tendency to present in advanced stages. It frequently affects young women, with cancer family history, especially breast or ovarian cancer. The approved systemic therapy for triple negative breast cancer is chemotherapy; however, recently, targeted therapies with checkpoint inhibitors and polyadenosine diphosphate ribose polymerase inhibitors have been shown to be effective in selected patients and have been added to the therapeutic arsenal for triple negative breast cancer. Given the appearance of these new strategies, it seems relevant to understand the heterogeneity of this disease, the mechanisms of action behind new therapies, clinical results, and the criteria to select patients for molecular therapies. We present a review of the current systemic therapy of this breast cancer subtype.

Use of anterolateral thigh free flap for reconstruction and salvage of thoracic limb caused by an arteriovenous malformation.

Vascular arteriovenous malformations originate during the early stages of embryonic development and generally grow progressively, especially during adolescence and pregnancy. Limb salvage using microsurgery is presented, in a patient with an arteriovenous malformation who was initially a candidate for limb amputation. En bloc resection of the arteriovenous malformation of all segments with extended brachial approach and the cutaneous component was performed, with an anterolateral thigh free flap for the lateral reconstruction of the hand.

Biomedical image classification made easier thanks to transfer and semi-supervised learning.

BACKGROUND AND OBJECTIVES: Deep learning techniques are the state-of-the-art approach to solve image classification problems in biomedicine; however, they require the acquisition and annotation of a considerable volume of images. In addition, using deep learning libraries and tuning the hyperparameters of the networks trained with them might be challenging for several users. These drawbacks prevent the adoption of these techniques outside the machine-learning community. In this work, we present an Automated Machine Learning (AutoML) method to deal with these problems. METHODS: Our AutoML method combines transfer learning with a new semi-supervised learning procedure to train models when few annotated images are available. In order to facilitate the dissemination of our method, we have implemented it as an open-source tool called ATLASS. Finally, we have evaluated our method with two benchmarks of biomedical image classification datasets. RESULTS: Our method has been thoroughly tested both with small datasets and partially annotated biomedical datasets; and, it outperforms, both in terms of speed and accuracy, the existing AutoML tools when working with small datasets; and, might improve the accuracy of models up to a 10% when working with partially annotated datasets. CONCLUSIONS: The work presented in this paper allows the use of deep learning techniques to solve an image classification problem with few resources. Namely, it is possible to train deep models with small, and partially annotated datasets of images. In addition, we have proven that our AutoML method outperforms other AutoML tools both in terms of accuracy and speed when working with small datasets.

Estudio observacional prospectivo unicéntrico sobre el efecto de la prehabilitación trimodal en cirugía colorrectal / A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery

INTRODUCCIÓN: Se ha diseñado un protocolo de prehabilitación trimodal con el objetivo de valorar si contribuye a disminuir la morbilidad postoperatoria, valorar el efecto de la prehabilitación en la estancia hospitalaria global y analizar la evolución de la capacidad funcional antes y después de cirugía. MÉTODOS: Estudio observacional unicéntrico con pacientes con cáncer colorrectal intervenidos quirúrgicamente con intención curativa después de un protocolo de prehabilitación trimodal. Se recoge morbilidad postoperatoria según el Comprehensive Complication Index y estancia hospitalaria, y se compara con una matriz histórica. También se recoge capacidad funcional antes y después de la aplicación del protocolo de prehabilitación. RESULTADOS: En comparación con la población histórica se consigue disminuir el Comprehensive Complication Index global de forma estadísticamente significativa de 13,2 a 11,5. Desglosando por tipo de morbilidad, todas disminuyen en porcentaje sin conseguir significación (infección espacio quirúrgico del 11,7 al 8,4%; infección nosocomial del 15,8 al 10%, y morbilidad médica del 8,6 al 4,2%). La estancia hospitalaria global pasa de 6 a 4 días y el porcentaje de pacientes que se preparan en casa disminuye de forma estadísticamente significativa en ambos casos. CONCLUSIONES: La prehabilitación trimodal puede contribuir a disminuir la morbilidad postoperatoria y la estancia hospitalaria global de los pacientes intervenidos de neoplasia colorrectal

INTRODUCTION: A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery. METHODS: A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol. RESULTS: Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases. CONCLUSIONS: Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery

Reduction of the Carbapenemase Inactivation Method (CIM) assay time by real-time PCR.

Carbapenemase Inactivation Method (CIM) is a test to detect presence of the carbapenemase in Gram-negative bacteria. Determination of the carbapenemase production by inactivation of meropenem requires that a zone of control E. coli inhibition be measured approximately 6-24 h after plating. We have modified the CIM test by developing a rapid method which instead measures the growth of E. coli indicator strain ATCC 25922 using real-time PCR, referred to as a nucleic acid testing CIM (natCIM). Our natCIM, therefore reduces the detecting time from 6 to 24 h to approximately 4 h.

Identification through exome sequencing of the first PMM2-CDG individual of Mexican mestizo origin.

Congenital Disorders of Glycosylation (CDG) are scarcely reported from Latin America. We here report on a Mexican mestizo with a multi-systemic syndrome including neurological involvement and a type I transferrin (Tf) isoelectric focusing (IEF) pattern. Clinical exome sequencing (CES) showed known compound missense variants in PMM2 c.422G > A (p.R141H) and c.395 T > C (p.I132T), coding for the phosphomanomutase 2 (PMM2). PMM2 catalyzes the conversion of mannose-6-P to mannose-1-P required for the synthesis of GDP-Man and Dol-P-Man, donor substrates for glycosylation reactions. This is the third reported Mexican CDG patient and the first with PMM2-CDG. PMM2 has been recently identified as one of the top 10 genes carrying pathogenic variants in a Mexican population cohort.

Evaluación de la tasa de detección incidental de cáncer cutáneo: estudio prospectivo en un servicio hospitalario / Incidental Skin Cancer Detection in a Hospital Department: A Prospective Study

ANTECEDENTES Y OBJETIVO: El cáncer de piel es un motivo frecuente de derivación a dermatología, pero también puede ser un hallazgo incidental durante la exploración por otro motivo de consulta. El objetivo del estudio fue comparar las características de las lesiones diagnosticadas de un cáncer cutáneo de forma incidental y compararlas con aquellas que constituían el motivo de derivación con pacientes diagnosticados de cáncer de piel (carcinoma espinocelular, carcinoma basocelular y melanoma) durante un año en una consulta de dermatología. Se recogieron diferentes variables y se realizó el análisis estadístico mediante la prueba de la Ji cuadrado de Pearson comparando el grupo en el que el diagnóstico era el motivo de derivación frente al grupo en el que el diagnóstico fue hallazgo incidental. RESULTADOS: Se recogieron datos de 433 pacientes, con una mediana de edad de 72 años, con 233 (51,3%) pacientes del sexo femenino y un predominio de fototipos II y III. El carcinoma basocelular fue en todos los análisis la neoplasia más frecuente, representando un 68,4% (296/433). Un 26% de los tumores cutáneos malignos diagnosticados no estaban relacionados con el motivo de derivación. El análisis estadístico demostró que las diagnosticadas de forma incidental estaban localizadas en zonas no visibles, tenían un menor tamaño y menor tiempo de evolución. CONCLUSIONES: La alta tasa de cáncer de piel diagnosticado de forma incidental por el dermatólogo resalta la necesidad de realizar exploraciones exhaustivas a nuestros pacientes para facilitar la detección temprana y el tratamiento precoz

BACKGROUND AND OBJECTIVES: Skin cancer is a common cause for referral to dermatology, but it may also be an incidental finding during examination of patients referred for other reasons. The objective of the study was to compare the characteristics of skin cancer lesions (squamous skin carcinoma, basal cell carcinoma, melanoma) diagnosed at a dermatology department over 1 year between patients referred for suspected skin cancer and those referred for another reason but in whom skin cancer was detected as an incidental finding. Pearson's chi2 test was used to compare different study variables between the 2 groups. RESULTS: Data were collected from 433 patients with a mean age of 72 years; 233 (51.3%) of the patients were female. The most common skin types were Fitzpatrick types II and III. Basal cell carcinoma was the most frequent cancer in all the analyses and accounted for 68.4% of all cancers diagnosed (296/433). Twenty-six percent of the malignant skin tumors were detected incidentally. Statistical analysis revealed that these tumors tended to be located in nonvisible areas and were smaller and of more recent onset than tumors initially suspected to be malignant. CONCLUSIONS: The high rate of skin cancer diagnosed incidentally by dermatologists highlights the need to carry out thorough examinations of patients in order to facilitate early detection and treatment

A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery. / Estudio observacional prospectivo unicéntrico sobre el efecto de la prehabilitación trimodal en cirugía colorrectal.

INTRODUCTION: A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery. METHODS: A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol. RESULTS: Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases. CONCLUSIONS: Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery.

Incidental Skin Cancer Detection in a Hospital Department: A Prospective Study. / Evaluación de la tasa de detección incidental de cáncer cutáneo: estudio prospectivo en un servicio hospitalario.

BACKGROUND AND OBJECTIVES: Skin cancer is a common cause for referral to dermatology, but it may also be an incidental finding during examination of patients referred for other reasons. The objective of the study was to compare the characteristics of skin cancer lesions (squamous skin carcinoma, basal cell carcinoma, melanoma) diagnosed at a dermatology department over 1 year between patients referred for suspected skin cancer and those referred for another reason but in whom skin cancer was detected as an incidental finding. Pearson's χ2 test was used to compare different study variables between the 2 groups. RESULTS: Data were collected from 433 patients with a mean age of 72 years; 233 (51.3%) of the patients were female. The most common skin types were Fitzpatrick types II and III. Basal cell carcinoma was the most frequent cancer in all the analyses and accounted for 68.4% of all cancers diagnosed (296/433). Twenty-six percent of the malignant skin tumors were detected incidentally. Statistical analysis revealed that these tumors tended to be located in nonvisible areas and were smaller and of more recent onset than tumors initially suspected to be malignant. CONCLUSIONS: The high rate of skin cancer diagnosed incidentally by dermatologists highlights the need to carry out thorough examinations of patients in order to facilitate early detection and treatment.

Cefalea y déficit neurológico: piensa en HaNDL / Headache and neurological deficit: think of HaNDL

El síndrome HaNDL constituye una entidad poco frecuente caracterizada por la aparición de episodios de cefalea intensa y focalidad neurológica transitoria con peculiaridades en el LCR. Es considerado como un trastorno de curso benigno por su carácter reversible y autolimitado. Presentamos el caso de una niña de 12 años que consulta por cefalea de dos semanas de evolución y monoparesia del miembro superior izquierdo posterior que se percibió en su valoración inicial en Urgencias. Se realizó una TAC, con resultado normal, y de la punción lumbar se obtuvo un LCR donde destacaba una pleocitosis linfocitaria. La RMN cerebral mostró datos compatibles con HTIC. Tras los resultados de las pruebas complementarias fue diagnosticada de síndrome de HaNDL e inició tratamiento sintomático, presentando mejoría clínica progresiva. El síndrome HaNDL se trata de una entidad clínica rara y poco conocida que por sus peculiaridades puede generar inquietud. Existen casos y series de casos publicados en la literatura en pacientes adultos, siendo una patología más rara en la población pediátrica. Su diagnóstico diferencial es amplio y abarca patologías potencialmente letales, por lo que conocer las características clínicas y la evolución natural de este proceso resulta de utilidad en el diagnóstico diferencial de las cefaleas con déficit neurológico transitorio

HaNDL syndrome is a rare clinical condition characterized where episodes of severe headache and transient neurological focus with peculiarities in the CSF occur. It is considered a benign course disorder due to its reversible and self-limiting nature. We report the case of a 12-year-old girl who visits the hospital for a two-week headache and monoparesis of her left upper limb. After initial assessment in the emergency department, a CT scan was performed with normal results and a lumbar puncture from which a CSF was obtained showing lymphocytic pleocytosis. Brain MRI showed intracranial hypertension (IH) compatible data. After the results of the complementary tests, she was diagnosed with HaNDL syndrome and was prescribed symptomatic treatment, showing progressive clinical improvement. HaNDL syndrome is a rare and little-known clinical entity which, due to its peculiarities, may cause concern. Cases and series of cases published in the literature exist in adult patients, being a rarer pathology in the paediatric population. Its differential diagnosis is wide and includes potentially lethal pathologies. Therefore, it is useful to know the clinical characteristics and natural evolution of this process in the differential diagnosis of headaches with transient neurological déficit